Journal of Research & Innovation in Anesthesia

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VOLUME 5 , ISSUE 1 ( January-June, 2020 ) > List of Articles

Original Article

Audit of Anesthetic Management of Parturients with Cardiac Diseases Posted for Obstetric Procedures in a Tertiary Care Hospital

Priti S Devalkar, Priti Devalkar, Sweta V Salgaonkar, Mansi Badve

Keywords : Anesthesia, Cardiac monitoring, Cardiac parturients, Labor analgesia

Citation Information : Devalkar PS, Devalkar P, Salgaonkar SV, Badve M. Audit of Anesthetic Management of Parturients with Cardiac Diseases Posted for Obstetric Procedures in a Tertiary Care Hospital. Res Inno in Anesth 2020; 5 (1):1-5.

DOI: 10.5005/jp-journals-10049-0069

License: CC BY-NC 4.0

Published Online: 28-01-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

The obstetric patient with heart disease challenges the anesthesiologists’ skills. Pregnancy and labor due to hemodynamic burden and the hypercoagulable state compromise an already stressed cardiovascular system. In developed countries, congenital heart disease (CHD) is the most common cause whereas in developing countries, still rheumatic heart disease remains the major concern. Results: Over a period of 6 months, we encountered 30 patients with cardiac disease posted for different obstetric procedures. Anesthesia management was decided according to severity and pathophysiology of cardiac lesion and urgency of procedure. In this article, we have mentioned our experience with cardiac parturients with CHD, rheumatic heart disease, peripartum cardiomyopathy, and Takayasu arteritis. Conclusion: Effective management of obstetric patient with cardiac disease includes antepartum counseling, risk stratification, an optimization, monitoring and tailored anesthesia plan for labor, delivery, and obstetric procedure, and intensive care unit care in the immediate postpartum period.


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  1. Chestnut DH. Principles and practice of obstetric anaesthesia, vol. 3, Philadelphia, Pennsylvania: Elsevier Mosby; 2004. pp. 707–733.
  2. Ashrafi R, Curtis SL. Heart disease and pregnancy. Cardiol Ther 2017;6(2):157–173. DOI: 10.1007/s40119-017-0096-4.
  3. Harris IS. Management of pregnancy in patients with congenital heart disease. Prog Cardiovasc Dis 2011;53(4):305–311. DOI: 10.1016/j.pcad.2010.08.001.
  4. Luthra A, Bajaj R, Jafra A, et al. Anesthesia in pregnancy with heart disease. Saudi J Anaesth 2017;11(4):454–471. DOI: 10.4103/sja.SJA_277_17.
  5. Burt CC, Durbridge J. Management of cardiac disease in pregnancy. Contin Educ Anaesth Crit Care Pain 2009;9(2):44–47. DOI: 10.1093/bjaceaccp/mkp005.
  6. Gupta S, Partani S. Neuraxial techniques of labour analgesia. Indian J Anaesth 2018;62(9):658–666. DOI: 10.4103/ija.IJA_445_18.
  7. Choudhury M. Neuraxial anaesthesia in parturient with cardiac disease. Indian J Anaesth 2018;62(9):682–690. DOI: 10.4103/ija.IJA_474_18.
  8. Gelson E, Curry R, Gatzoulis MA, et al. Effect of maternal heart disease on fetal growth. Obstet Gynecol 2011;117(4):886–891. DOI: 10.1097/AOG.0b013e31820cab69.
  9. Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001;104(5):515–521. DOI: 10.1161/hc3001.093437.
  10. Chohan U, Afshan G, Mone A. Anaesthesia for caesarean section in patients with cardiac disease. J Pak Med Assoc 2006;56(1):32–38. DOI: 10.1016/S1726-4901(09)70108-X.
  11. Drenthen W, Pieper PG, Roos-Hesselink JW, et al. Outcome of pregnancy in women with congenital heart disease. J Am Coll Cardiol 2007;49(24):2303–2311. DOI: 10.1016/j.jacc.2007.03.027.
  12. Gelson E, Johnson M, Gatzoulis M, et al. Cardiac disease in pregnancy. Part 1: congenital heart disease. Obstet Gynaecol 2007;9(1):15–20. DOI: 10.1576/toag.9.1.015.27291.
  13. Veldtman GR, Connolly HM, Grogan M, et al. Outcomes of pregnancy in women with tetralogy of Fallot. J Am Coll Cardiol 2004;44(1): 174–180. DOI: 10.1016/j.jacc.2003.11.067.
  14. Kuczkowski KM. Labor analgesia for the parturient with cardiac disease: what does an obstetrician need to know? Acta Obstet Gynecol Scand 2004;83(3):223–233. DOI: 10.1111/j.0001-6349.2004.0430.x.
  15. Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr 2016;27(2):111–118. DOI: 10.5830/CVJA-2016-052.
  16. Regitz-Zagrosek V. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018;39(34):3165–3241. DOI: 10.1093/eurheartj/ehy340.
  17. Sen S, Chatterjee S. Epidural anesthesia: a safe option for cesarean section in parturient with severe pulmonary hypertension. J Nat Sci Biol Med 2016;7(2):182–185. DOI: 10.4103/0976-9668.184708.
  18. Ramachanran R, Rewari V, Trikha A. Anaesthesia management of patients with peripartum cardiomyopathy. J Obstet Anaesth Crit Care 2011;1(1):5–12. DOI: 10.4103/2249-4472.84249.
  19. Tiwari AK, Tomar GS, Chadha M, et al. Takayasu's arteritis: anesthetic significance and management of a patient for cesarean section using the epidural volume extension technique. Anesth Essays Res 2011;5(1):98–101. DOI: 10.4103/0259-1162.84184.
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